Professional Engineer Renewal Application

Click here to START or CLEAR, then hit the TAB button

Professional Engineer Renewal Application

Renew your Professional Engineer license. Online: Or mail this completed form and a check or money order for the renewal fee (payable to the Department of Licensing) to: Board of Registration for Professional Engineers and Land Surveyors Department of Licensing PO Box 3777 Seattle WA 98124-3777

For questions or language help call: (360) 664-1575

Fees $116 for 2-year renewal $174 for late renewal (90 days after license expiration date)

Licenses are available for self-printing with an online account.

If you want us to print and mail your license add a $5 print fee for each copy to your payment.

$0 self-print license online.

$5 each. DOL print and mail license. Quantity

Total $

Applicant information

PRINT or TYPE Name (Last, First, Middle)

License number

Mailing address

City

State

ZIP code

(Area code) Phone number

Email

Legal background

Answer the following

Answer the questions below. If you answer "Yes," attach a detailed explanation.

1. Within the last 5 years, in this state or any other jurisdiction, have you had any action (fine, suspension, revocation, censure, surrender, etc.) taken against any professional or occupational license, certification, or permit held by you? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

2. Within the last 5 years, in this state or any other jurisdiction, have you defaulted, or been convicted of, or entered a plea of no contest to a gross misdemeanor or felony crime? (Don't include traffic convictions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

I declare under penalty of perjury under the law of Washington that the foregoing is true and correct.

Date and place

TYPE or PRINT Name

X When you have completed this form, please print it out and sign here.

Applicant signature

Providing any false information in this application may be cause for denial, suspension, or revocation of your professional license in the State of Washington.

ENLS-651-023 (R/6/20)WA

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download